Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil.
Braz J Infect Dis. 2012 Sep-Oct;16(5):416-9. doi: 10.1016/j.bjid.2012.08.006. Epub 2012 Sep 12.
The molecular epidemiology of carbapenemase-producing Klebsiella pneumoniae (KPC) has been largely investigated, but limited clinical information is available. A case-control study was performed to evaluate the risk factors for KPC bacteremia in hospitalized patients. Cases were patients with KPC bacteremia and controls were patients with non-KPC bacteremia. A total of 85 patients were included, 18 (21.2%) were KPC, and 67 (78.8%) were non-KPC (40 [59.7%] of them were extended-spectrum beta-lactamase producers). All KPC isolates were type 2 producers. These isolates belong to five distinct clones. Multivariate analysis showed that age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02 - 1.11; p = 0.004), presence of mechanical ventilation (OR, 11.1; 95% CI, 1.92 - 63.3; p = 0.007) and fluoroquinolone exposure during hospitalization (OR, 28.9; 95% CI, 1.85 - 454.6; p = 0.02) were independent risk factors for KPC in patients with K. pneumoniae bacteremia. Factors associated with severity of illness, such as age and mechanical ventilation, seem to be the main risks factors for KPC. Fluoroquinolones use might be a risk factor for KPC bacteremia. Further investigations on risk factors for KPC are warranted.
产碳青霉烯酶肺炎克雷伯菌（KPC）的分子流行病学已得到广泛研究，但临床相关信息有限。本项病例对照研究旨在评估住院患者发生产 KPC 肺炎克雷伯菌菌血症的危险因素。病例为产 KPC 肺炎克雷伯菌菌血症患者，对照为非产 KPC 肺炎克雷伯菌菌血症患者。共纳入 85 例患者，18 例（21.2%）为产 KPC，67 例（78.8%）为非产 KPC（其中 40 例[59.7%]为产超广谱β-内酰胺酶）。所有 KPC 分离株均为 2 型产酶株。这些分离株属于五个不同的克隆。多变量分析显示，年龄（比值比 [OR]，1.06；95%置信区间 [CI]，1.02-1.11；p = 0.004）、存在机械通气（OR，11.1；95% CI，1.92-63.3；p = 0.007）和住院期间氟喹诺酮暴露（OR，28.9；95% CI，1.85-454.6；p = 0.02）是肺炎克雷伯菌患者发生产 KPC 菌血症的独立危险因素。与疾病严重程度相关的因素，如年龄和机械通气，似乎是产 KPC 的主要危险因素。氟喹诺酮类药物的使用可能是产 KPC 菌血症的危险因素。需要进一步研究产 KPC 的危险因素。
